Suresh Sharma, P.G. Registrar (Surgery,
D.C. Merwaha, M.S. (Surgery) Assoc. Prof.
and
Prof. R.R. Gupta, M.S. (Surgery)
Prof. and Head, Dept. of Surgery
Indira Gandhi Medical College, Shimla, H.P., India.

Controversies do exist in literature on the role of UTI in calculogenesis. It has been postulated that the role of bacterial infection varies in different geographical regions. The present study was undertaken to establish the correlation of UTI with prevalence of urinary stone in the Shimla hills.

Bacteriological study was done on the urine of 80 patients of urolithiasis, admitted to the Indira Gandhi Medical College, Shimla from January 1987 to December 1987. The urine culture of all the patients was done during the pre-operative period using blood agar and MaConkey’s agar media. The bacteria were recognised by Cruickshank’s method. Significant bacteriuria (count more than 10⁵ organisms/ml) was determined by the method of Leigh and William. All the patients were given suitable antibiotics for one week after culture and sensitivity.

Forty patients having stones up to 1 cm. in diameter (radiologically proven), were given Cystone (Himalaya), 2 tablets t.i.d. for six weeks to three months. Sixteen patients were from the positive culture group, nine having E. coli infection. Radiological examination, urine culture and microscope examination were repeated after six weeks.

Urine culture of the 80 patients of urolithiasis showed that 31 had significant bacteuria (count >10⁵ organisms/ml), whereas 40 cultures were sterile. Urea-splitting bacteria were isolated from 18 (58%) patients with bacteriuria. E. coli was the commonest organism (35.5%), followed by Klebsiella and Pseudomonas (19.4% each), Proteus (13%), Streptococci (6.4%) and Staphylococci (3.2%) (Table 1).

Urine analysis of the patients revealed RBCs in 37 (46%), pus cells in 64 (80%), and phosphate crystals in 27 specimens (34%) (Table 2). The most common presenting symptom was pain (83%) followed by dysuria (24%), frequency (20%) and haematuria (18%) (Table 3).

In the Cystone-treated group, repeat radiological examination after six weeks revealed decrease in stone size in 9 patients. Smaller stones, approximately of the size of a ‘grain’, were passed per urethra in four patients. Out of 16 positive culture patients, only two of them were found to have Pseudomonas after 6 weeks of treatment. On microscopic examination of the urine, all the samples were found to be free from pus cells, except in eight samples having 6-8 pus cells per high field.

In the control group, out of 15 positive culture patients, four were found to be culture positive after 6 weeks, eight patients had plenty of pus cells and fourteen had 6-8 pus cells per high field (Table 4).

Urinary tract infection (UTI) is frequently found in patients with urinary stone disease. The high incidence (38.6%) seen in the present study is in close agreement with the observations of Malhotra et al. (41.5%) and Williams (31%).

Fifty eight percent of the organisms responsible for the infection were mostly ureasplitting. Of these Klebsiella and Pseudomonas were found in 66.6% of the patients. Non urea-splitting organisms were isolated in 42% of the positive culture cases. E. coli was isolated from 35% of the total positive cultures and formed 85% of the urea splitters. In the Williams series, 78% of the total positive cultures were E. coli, whereas Kumar et al. isolated E. coli in 37.5%.

Although there is some relationship between UTI and calculogenesis, yet many patients may display chronic UTI without stone disease. The present study also indicates that most of the urolithiasis patients (62%) did not have any UTI. It is also recognised that infection by urea-splitting organisms may contribute to calculogenesis by splitting urea and ammonia which, in turn, alkalinise the urine. At such high pH values, phosphate precipitates with calcium, magnesium and ammonium.

Cystone was found to be a good alternative to surgery for urinary stones less than 5 mm in diameter. Cystone has a definite role in UTIs, particularly E. coli infections and in the prophylaxis of recurrent UTIs which are common in stone patients.

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